Hysteroscopy - Pain Relief

[HebeJeeby]

I’ve just been taken off the cancer pathway as I’ve had a test of the lining of my womb and all is ok. I’ve been experiencing bleeding whilst in HRT and the Dr wanted to get me tested. The lining of my womb is 2mm thicker than it should be hence the test which has come back normal. However, due to the excessive bleeding they want to do a hysteroscopy to investigate the bleeding.

I’ve read that this procedure can be very painful and indeed 2 women I know found the pain excruciating and couldn’t continue. One woman had to then have it under general anaesthetic. I rang to ask about pain relief and got told to have a paracetamol one hour before my appointment. I said that i wasn’t happy with this for the reasons I’ve just written and the NP is going to call me on Monday to discuss. I found the initial procedure to suck cells form my womb very painful but it was bearable as it only lasted about 30 seconds. Apparently a hysteroscopy can take anything from 5 to 30 minutes.

Has anyone had a hysteroscopy and what was it like? Did you get offered or have any pain relief. I’m feeling so anxious about it and can’t believe that anyone would think I took to shove a camera into the womb and not think that this is going to hurt. Can I insist on proper pain relief like a local anaesthetic? Thank you.

thebms.org.uk/publications/bms-guidelines/management-of-unscheduled-bleeding-on-hormone-replacement-therapy-hrt/

• Women with a thickened endometrium on TVS (> 4 mm for ccHRT or > 7 mm for sHRT) should be offered referral to the urgent suspicion of cancer pathway (USCP) for endometrial assessment (biopsy and / or hysteroscopy).

• In the presence of a normal endometrial biopsy, discuss adjustments in the progestogen and provide reassurance for three months. If hysteroscopy and biopsy are normal, reassurance can be provided for six months.

What the BMS guidance says is that if the lining is thicker (yours is on continuous combined) you should have a biopsy AND/OR hysteroscopy

If the biopsy is normal, you can have adjustments to the progesterone.

You should have a full consultation on what type of HRT you're on. Combined continuous is if you're over 54 and no periods for a year prior to HRT, etc.

If you are not post menopause, you should not be using continuous combined HRT. This is because your own hormones will override it and the womb lining will be thicker and bleed.

I appreciate your GP is being cautious but the key is if you're on the right HRT.

I’ve had two with no problems. Like previous posters, it was no more uncomfortable than a smear. The first time I was offered the option of starting and, if I found it too uncomfortable, rescheduling for a general anaesthetic. There was gas and air on hand and they were insistent that I keep using it but I really didn’t think it was necessary.

We are all different, and I do think that if you’ve had a bad experience you are likely to post about it, but maybe less likely if it’s gone smoothly.

Now, ask me about a laparoscopy and I’ll tell you about the excruciating pain I experienced as I came round from the GA.

https://www.menopausematters.co.uk/postmeno.php

When you started HRT, your GP should have discussed where you were with your periods.

If you are under 54 and had a period during the 12 months before starting HRT, you should be on sequential. This is HRT that mimics a natural cycle so you get a withdrawal bleed each month (a bit like the Pill.)

If you are over 54 and were period-free for at least 12 months before HRT, you can use what you're on now.

Exactly this. The nurse assured me I could have a LA and gas and air. The Dr then advised it’s more expensive to have anaesthetic if any kind and LA would be extremely painful! I asked if they routinely carry out vasectomies with just paracetamol and ibuprofen for pain relief. Of course they don’t. They assume women are happier to withstand a higher pain threshold which is a crock of bs. Post menopause hysteroscopy can be more tricky and painful especially if you have atrophy.

I highly recommend asking your gp for a dose of diazepam to take prior to procedure if your hospital doctor is likely to behave like a dickish gaslighter. There were reports of my hospital pinning women down so they had it done without any pain relief so I dosed up on diazepam beforehand.

I’ve had 2 with just paracetamol and was fine with both. I think experiences seem to vary a lot as I wouldn’t say I had a high pain threshold, it just didn’t hurt. I was reassured before the first one, that if it was painful, they’d stop and book me in for a GA so that put my mind at ease. Both times I had it done, there was an extra Health Care Assistant chatting to me the whole time which was a great distraction. I think it’s reasonable to request pain relief if you feel you’ll need it but don’t assume it will be painful because it isn’t for everyone. I’d have another with just paracetamol.

I had one with only paracetamol and it was fine. In my area they offer a GA when you book, it takes a little longer to get an appointment and I didn't want to wait so I took the risk.

If you are worried at all then insist on what you need to make the procedure easier. Pain tolerance is so individual.

I had mine under GA but not for pain reasons, it’s because I have history of sexual abuse and rape. I just physically would not be able to do it if there were men involved even though it was a cancer referral so it was important and urgent. Because of another medical condition I have, they refused GA and pushed for spinal before they finally agreed to GA, at a certain hospital with specialist facilities. Under this (stupidly verbal!) agreement I actually had two OPs booked where the anaesthetist on the day refused a GA after I had turned up! It was very very stressful. In the end my consultant for the “too risky for GA” condition sorted it for me. They wrote a blunt brief letter stating patient has a history of rape so do not refuse the GA she needs to get this done quickly (plus a stern “why hadn’t they contacted this consultant if they didn’t feel confident instead of breaking the 2WW protocol etc etc”. ) It was done within two days! Funnily enough, this consultant is a man but understood and has sense and sees the bigger picture.

So there are multiple reasons why differing “pain relief” is needed, it’s not always “pain”. I just needed to be completely unaware of it. A need not a want. I genuinely wouldn’t have had it done without this, turned out it was a bloody good job I had it. (Not wanting to alarm you @HebeJeeby my referral and circumstances are completely different to yours! Best of luck to you whatever you decide )

How it should be. It’s 2025, we’ve made so many medical advances yet still putting women through brutal procedures when we don’t need to.

Anything they suggest paracetamol for or mention they words discomfort, I want sedation or GA

The clinic rang me this morning and were lovely. I am to go in for my appointment and tell them I want a GA and they will put me on the waiting list. They did start the call saying just pop a couple of paracetamol 30 minutes beforehand but I told them I wasn’t happy to do that and wanted to chat through other options for pain relief. She was very nice and it seems like it’s all sorted. I’m pleased but I don’t think it’s right that women have to advocate for pain relief they are entitled to rather than it being automatically offered. Thank you to everyone for sharing their thoughts, experiences and advice.

Glad it’s worked out but you’re right, you shouldn’t have to ask.
it should be a) offered
b) honest warning of what it’ll be like/level of pain instead of “some discomfort”

There is a national campaign for hystoscopy to be done with pain relief if needed.
I saw it on Instagram.
My friend had it with no pain relief and said it was fine , I was going to do the same but as they wanted to remove a polyp or two as the day got closer I panicked and rang my GP in tears.
They said I can have an injection in the cervix , they couldn't offer gas and air at that time or sedation so I asked for a GA .
I waited an extra 5 weeks for it but it was such a relief and had it 3 weeks ago , home 4 hours later.